CRAFTON HILLS COLLEGE FOUNDATION
LOAN AGREEMENT
Name:
____________________________________ Student ID # _________________
Address:
____________________________________ Telephone: __________________
____________________________________
E-mail:
____________________________________
Referred by (Printed Name) ________________________ Signature: ____________________
Title: _________________________________________
(CHC Faculty/Counselor/Staff)
Extension: ____________________
(Book Loans not to exceed $350.00 for Fall & Spring Semesters; $200 for Summer Session.)
Brief statement of need and purpose of loan:
Do you currently have an unpaid book loan with the CHC Foundation?
______________
I understand that failure to repay these funds may affect my ability to remain in or enroll in
classes at Crafton Hills College.
______________________________________
Print Name
______________________________________
Date
______________________________________
Signature - Foundation Representative
____________________________________
Signature